1. Technical Field
The present invention relates generally to a system for providing web-based data collection and management in a managed care organization.
2. Description of the Related Art
The business processes currently in place in almost all managed care organizations (MCO) are needlessly complex and inefficient, requiring a great deal of manual labor and resultant expense. FIG. 1 shows a simple example illustrating such inefficiencies. This drawing illustrates how the key constituents (members 100, employers 102 and providers 104) now carry out the simple task of making an inquiry to the MCO. As illustrated, the MCO typically provides or uses a member services call center 106, an account service call center 108, and a provider service call center 110. Data queries generated from the member services call center 106 are processed by a member services database 107, while data queries generated from account services and provider services are processed by the account service database 109 and provider service database 111. When a member 100, an employer 102 or a provider 104 desires to make an inquiry, he or she typically accesses the MCO via a telephone 115, and requested information 117 is usually returned by mail 118. Another example of the inefficiencies inherent in the current system is shown in FIG. 2, which illustrates how an employee 200 enrolls in his or her employer's managed care program. In this example, the employee 200 fills out enrollment forms 202, which are then forwarded on to the employer's HR department 204. The HR department 204 enters such data into the employer's information system 206 and then forwards the information via regular mail to the managed care organization 208. The MCO then has to enter the data in its information system 210. Such processes are time consuming and inefficient.
In addition to the structural and administrative problems inherent in the existing MCO industry, several major trends are now emerging in the health care industry as a whole. Employers are taking a less active role in the payment of and administration of health care benefits. The use of global, interconnected computer systems, such as the Internet, have become commonplace and inexpensive. Moreover, new standards, systems and processes for the health care industry infrastructure have begun to be proposed and implemented. Finally, there has been significantly increased demand by consumers for health-related information. Indeed, consumers are becoming more educated and participatory in clinical decision making and are demanding more from physicians.
The Internet has been a major catalyst for change. It is estimated that there are now over 65 million U.S. adults with access to the Internet, which represents over 25% of the population. The Internet is rapidly becoming the most important communications channel for health plans, and many companies have begun to provide health care-related services online. Healtheon Corporation provides software and services that enable healthcare information, both medical and administrative, to be exchanged over the Internet. The company provides a system to automate such tasks as HMO enrollment, referrals, data retrieval, and claims processing for use by insurers, doctors, pharmacies, and consumers. Healtheon, through WebMD, also provides Internet-based technology that connects physicians, hospitals, payors, and consumers to an array of interactive tools and services. Other companies are deploying solutions as application services. Alteer, for example, is an application service provider (ASP) that provides a web-based workflow solution to address administrative and communication needs of healthcare professionals and consumers. Alteer establishes healthcare professionals' practices as online healthcare portals. As a result, patients can visit the respective physician web sites and search for information specific to their physician's expertise and their personal needs. Other companies now provide online solutions for managing patient information access, contract compliance and billing, and clinical performance analysis. Still others provide online solutions that allow physicians to manage their clinical information and secure access to the same information by patients so that patients can actively participate in their personal family health management.
Currently, every constituent of the health care system collects a set of data that is likely to be somewhat different from one party to another. This is manifested in a health care record that is collectively strewn across the health care landscape in various multiple enterprises. The present effort of collecting each element of the data requires that the data set be as small as possible, containing only essential information. The ability to share information, such as submitting a claim to a managed care organization or authorizing a visit to a specialist, is difficult because no party can ensure that they are matching records on the same individual.
It would be desirable to be able to leverage the Internet to allow loosely-related parties to share a common set of data, with one common identification number, allowing what was previously disparate data to become meaningful, actionable information.